International Journal of Trend in Scientific Research and Development (IJTSRD)
Volume 4 Issue 4, June 2020 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470
Interactivity in Goodsalls' Rule and Fistula-in-ano
Samaranayake G. V. P1, Chandimal K. M2
1Department
of Ayurveda Basic Principles, Gampaha Wickramarachchi Ayurveda Institute,
University of Kelaniya, Yakkala, Sri Lanka
2Department of Anatomy, Faculty of Medicine, Wayamba University of Sri Lanka,
Negombo-Kurunegala, Sri Lanka
ABSTRACT
Fistula-in-ano is a tract lined by granulation tissue which opens deeply in the
anal canal or rectum and superficially on the skin around the anus. Managing
fistula-in-ano is a challenging task. Because recognizing the internal opening
and cause of the fistula tract is difficult. Both external and internal openings of
the fistula tract are essential for the complete identification of the tract. The
purpose of the present study was to study the relevance between Goodsall's
rule and course of the fistula tract. A sample of 106 patients with simple fistula
was studied. In this study Hydrogen Peroxide was injected by using syringe
through the external opening of the fistula and seenthe appearance of air
bubbles which are come out from the internal opening. The site and number of
internal and external openings and the course of the tract were recorded. The
median age of the participants was 37 years. The majority were male
(57.54%). Thirty one point one percent (31.1%) showed intersphincteric
fistula, 51.8% showed transphincteric fistula and 16.9% had superficial fistula.
The overall predictive accuracy of Goodsall's rule in studied group was 68.3%.
It is significantly associated with the type of fistula. The high predictive
accuracy in superficial fistula (94.4%), intersphincteric fistula (84.4%) and
transphicteric fistula (69.09%) were observed. It was concluded that,
Goodsalls' rule was not accurate in 31.7% of all fistulae; it can be used as a
guide in locating the course of the tract and the internal opening.
How to cite this paper: Samaranayake G.
V. P | Chandimal K. M "Interactivity in
Goodsalls' Rule and Fistula-in-ano"
Published
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International Journal
of Trend in Scientific
Research
and
Development (ijtsrd),
ISSN:
2456-6470,
Volume-4 | Issue-4,
IJTSRD31383
June 2020, pp.14271428,
URL:
www.ijtsrd.com/papers/ijtsrd31383.pdf
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KEYWORDS: Goodsalls' rule, fistula-in-ano, Sri Lankan population
INTRODUCTION
Fistula-in-ano is a tract lined by granulation tissue which
opens deeply in the anal canal or rectum and superficially on
the skin around the anus (Cirocco et al., 1991). At present,
several treatment modalities are being used by allopathic
medicine to manage the fistula-in-ano. Managing fistula-inano is a challenging task. Because recognizing the internal
opening and cause of the fistula tract is difficult. Both
external and internal openings of the fistula tract are
essential for the complete identification of the tract. David
Henry Goodsall described a rule to explain the location of the
fistula tract. Both external and internal openings of the
fistula tract are essential for the complete identification of
the tract.
David Henry Goodsall states that if external opening is
situated in the posterior to the transverse anal line, at that
time tract will open in to the midline posteriorly and if the
external opening situated anterior to the transvers anal line
at that time it usually associated with a radial tract (Ross et
al., 1988). The purpose of the present study was to study the
correlation between Goodsall's rule and course of the fistula
tract.
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Unique Paper ID – IJTSRD31383
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Figure 1 - Goodsall’s Rule
Methodology:
Patients those who had simple fistula-in-ano were included
in the study. Those who had following complex fistula were
not considered for this study.
Multiple fistula
Horseshoe fistula
tract length >10cm
severe suppurative fistula
Fistula with secondary causes; such as trauma, TB,
carcinoma, Crohn's disease were excluded from the
study.
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International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470
After taking history, digital per rectal examination and
proctoscopy were carried out in all patients. All patients
were assessed in the lithotomy or left lateral position
depending on the case. Hydrogen Peroxide was injected by
using syringe through the external opening of the fistula and
seen the appearance of air bubbles which are come out from
the internal opening. The site and number of internal and
external openings and the course of the tract were recorded.
Data were analyzed by using SPSS.
Results:
The median age of the participants was 37 years. (Range 1875). The majority of the patients were males (57.54%).
Thirty one point one percent (31.1%) had intersphincteric
fistula, 51.8% had transphinteric fistula and 16.9% had
superficial fistula. The overall predictive accuracy of
Goodsall's rule in patients was 68.3%. Goodsall's rule was
not related to gender and it was significantly associated with
the type of fistula. (P value should be given as it is
significant)
Table 1 - Correlation between course of fistula tract and Goodsall's rule
Correlation between course of fistula tract and Goodsall's rule P value
Yes (%) No (%)
Male 49 (80.32) 12 (19.6) 0.187
Sex
Female 29 (64.4) 16 (35.5)
Type
Superficial 17 (94.4) 01(5.5) 0.001
Inter-sphincteric 28 (84.4) 05 (15.1)
Trans-sphincteric 38 (69.09) 17 (30.9)
Figure 2 - Relation between Goodsall’s Rule with Gender and Type of Fistula-in-ano
100
90
80
70
60
50
40
30
20
10
0
Discussion:
According to the analysis, the predictive accuracy for simple
fistula was 78.3%. Fistula with an anterior external opening
had a predictive accuracy of 76.3% and posterior external
opening had a predictive accuracy of 79.4%. The difference
was not statistically significant. Goodsall's rule was able to
predict the internal opening in 97.1% of superficial fistula,
84.1% of inter-sphincteric fistula and 69.3% of transsphinteric. The difference was statistically significant.
(p=0.001).
Conclusion:
It was concluded that, Goodsalls' rule was not accurate in
31.7% of all fistula. It can be used as a guide in locating the
course of the tract and the internal opening.
References:
[1] Cirocco W. C., Reilly I. C., Challenging the predictive
accuracy of Goodsall's rule for anal fistulas, Dis Colon
Rectum 1992; 35:537-42
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Superficial
Inter-sphincteric
Trans-sphincteric
[2] Parks A. G., Stitz R. W., The treatment of high fistula-inano, Dis Colon Rectum, 1976; 19: 487-99
[3] Mallick K. K., Kamil N. B. M., Relevance of Goodsall's
Rule in Fistula-in-ano, Malay: 52:73
[4] Jayarajah U., Samarasekara D.N., Predictive accuracy of
Goodsall's rule for fistula-in-ano, ANZJ Surg 2017:9699
[5] Belliveau P. Anal Fistula: Current Therapy in Colon and
Rectal Surgery, Philadelphia.
[6] Cosman BC All’s Well That Ends Well: Shakespeare’s
treatment of anal fistula. Dis Colon Rectum July, 1998:
914-24.
[7] Rosen L. Anorectal abscess-fistulae. SurgClin North Am.
Dec. 1994: 74(6):1293-308.
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